Patient information What you need to know on discharge from hospital - Information for Patients with an Ocular Tumour Ophthalmology Directorate PIF 564 V7
This leaflet should provide you with the relevant information regarding your aftercare on returning home after your operation. Sister Hebbar, Specialist Ocular Oncology Nurse, will phone you within a few days of your discharge from hospital. If you have any questions or problems, please get in touch with Sister Hebbar during office hours by phone or e-mail, leaving a message on her answer-phone if she is not available. At other times or if the problem is urgent you can phone the nursing staff at Ward 9Y. Please see contact details below. General Advice Eye Drops As a rule, antibiotics are given to reduce the risk of infection. Steroid drops are used to minimise any inflammation inside your eye. Dilating drops improve comfort by relaxing your pupil and if there is any inflammation inside your eye they also prevent adhesions between the iris and lens.
The prescription time for each drop depends on the type of treatment and advice specific to each operation is given below. Do the eye drops have any side effects? Pupil-dilating drops (such as Atropine, Cyclopentolate and Tropicamide) can cause blurred vision and discomfort in bright light. Steroid drops reduce your eye s resistance to infections such as herpes simplex (similar to cold sores but affecting your eye). In addition, they can cause raised intraocular pressure if taken for more than four weeks and such ocular hypertension can cause optic nerve damage and visual loss (i.e. steroid glaucoma ). If taken for years, topical steroids can cause cataract. The antibiotic drops rarely cause side effects other than allergy in some people. Allergy to any drops can occur either immediately or after a delay of days or weeks. This would cause swelling, redness, itching and watering of your eye. What happens when the eye drops run out? A bottle of eye drops contains enough of the preparation to last for one month, so that the drops should not run out.
How long do the eye drops last? Once opened, a bottle of drops should be discarded after twenty-eight days, even if the drops have not run out. If drops are likely to be necessary for more than one month, then by the third week of your course of treatment you should obtain a new prescription from your General Practitioner (GP). Driving If you are dilating one or both pupils you are still allowed to drive as long as you can read a number plate from the required distance of 20.5 metres. Nevertheless, when one pupil is dilated it can be difficult to judge distances even if you can see clearlyout of the other eye. It would be best not to drive. Various eye drops are used. Particular advice on each one is given on the following page.
Returning to work
The time when you can return to work depends on several factors such as type of operation, type of occupation, visual requirements for work, and environmental hazards such as dust. Any stress related to treatment or diagnosis might make it more difficult to cope with problems at work. As a rule, we suggest convalescence periods of one week after marker insertion or plaque radiotherapy, four weeks after enucleation, and four weeks after local resection. Sports and swimming The considerations relating to work after surgery also apply to sport and other recreational activities. Swimming may cause ocular irritation and infection if water gets into your treated eye within a week of surgery. Personal hygiene It is safe to bathe, shower and wash your hair any time after surgery, but avoid getting water into your eye. Follow-up appointments If you will be returning to our hospital for follow-up assessment at any time then you will receive an appointment letter within ten days of your discharge from the ward.
If you will be attending your local hospital for follow-up care then you will receive an appointment directly from that hospital. You should receive a copy of our letter to your consultant asking for an appointment to be arranged at your hospital. Frequently-asked questions I can still see flashes of light after my operation. Does this matter? No. These can continue for months or years and do not mean anything is wrong. Do any stitches need to be removed from my eye? Fine blue stitches dissolve in time and should not need to be removed. After the trapdoor operation black nylon stitches might need to be removed after a few months once your eye has healed. Will the markers need to be removed from my eye? As a rule, tantalum markers for proton beam radiotherapy are left in place permanently. Occasionally, markers located near the front of the eye are removed if these are visible and if they threaten to damage the overlying conjunctiva (i.e. the transparent skin over the white of the eye).
Can I have an MRI scan if markers have been inserted behind my eye for proton beam radiotherapy? Yes. The markers are made of tantalum, which is entirely non-magnetic. Can I drive home after attending Clatterbridge Hospital? You can drive home after attending Clatterbridge Hospital. If your pupil has been dilated, please see the relevant advice above. How long should I wear an eye-pad after I leave the hospital? You should wear an eye-pad as little as possible after leaving the hospital as fresh air reduces the chances of infection. Can I drive if I have permanently lost vision in one eye? If you have permanently lost vision in one eye then as soon as possible you should inform the DVLA at Swansea, and your driving insurance company.
The DVLA will contact us or another practitioner for a report on your vision and will usually inform you that you are allowed to drive while waiting for this report, provided you meet the legal requirements for driving with your other eye. Am I allowed to fly soon after my operation? You can fly any time after your operation, as long as a gas bubble has not been injected into the eye as part of a trapdoor operation (we will let you know if this has been included in your operation). What should I do if I have not received an appointment from my hospital? If you have not received an appointment from your hospital within one week of the intended appointment date then you should telephone your local hospital, asking to speak to the consultant s secretary. If I have had radiotherapy is there still any dangerous radioactivity left behind? There is no radioactivity from the moment the plaque is removed or from the time when the proton beam is switched off. Can I have dental treatment? Yes, you can have any dental treatment you need following your eye treatment.
My eye is painful and/or bloodshot, what should I do? A painful or bloodshot eye is to be expected after ocular surgery but should improve on a daily basis. You should therefore see your doctor if it gets worse, your sight deteriorates, or there is increased discharge from your eye. Can I use hospital transport to travel to Liverpool for my follow-up clinic assessment? Hospital transport is very expensive and in short supply. Only patients who for medical reasons cannot travel to the hospital in any other way should therefore use it. How will I get the results of pathology (i.e. microscope exam) or cytogenetics ( special DNA test)? Any pathology results will be sent to your ophthalmologist within six weeks of your operation. The cytogenetic results can take up to one month to become available. They will be sent to our medical oncologist, who will invite you to his clinic to discuss these results and plan your future care. If you are unable to travel to his clinic then you should phone his secretary so that arrangements can be made for you to see a medical oncologist closer to home.
Will I be contacted in the future? We may in future send you questionnaires, or invite you to participate in a Patient Focus Group, send you a newsletter and other letters. Such contacts are likely to be few and far between. We hope you find this leaflet useful but would welcome any suggestions for improvement. Further Information Sister Gill Hebbar (your key worker) Specialist Ocular Oncology Nurse Tel: 0151 706 3976 Textphone Number:18001 0151 706 3976 Fax: 0151 706 5436 E-mail: gillian.hebbar@rlbuht.nhs.uk Ward 9Y Tel: 0151 706 2496 / 2498 Textphone Number: 18001 0151 706 2496/2498 Author: Ophthalmology Directorate Review Date: October 2017
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